家屬對於慢性阻塞性肺疾病人於生命末期不予維生處置的意向

The Intention of Families toward Withholding Life-Sustaining Treatments for Patients with COPD in End-Of-Life

陳亭儒(Ting-Ru Chen) ； 胡文郁(Wen-Yu Hu) ； 邱泰源(Tai-Yuan Chiu) ； 葉淑玲(Shu-Ling Yeh)

《安寧療護雜誌》 19卷2期 (2014/07) Pp. 138-154

https://doi.org/10.6537/TJHPC.2014.19(2).2

摘要

研究目的：了解家屬對於慢性阻塞性肺疾（COPD）病人於生命末期不予維生處置（LST）的意向及其相關因素。研究方法：橫斷式調查性研究設計，以結構式問卷訪談COPD病人之主要照顧家屬。研究結果：有82位家屬參與研究，大多為病人的子女及配偶。多半家屬認為生命末期LST應由病人自己做決策，一半以上家屬不知道病人對於LST之意願；知道病人意願或生命末期醫療目標偏好舒適性照顧的家屬，其不接受維生處置意向較高。當病人處於不同狀況，家屬對於病人為目前健康的狀況，其不予LST意向最低，當病人為植物人狀態則不予LST意向最高；在十二項維生處置中，以「使用抗生素」接受度最高，「氣管切開術」最低。家屬對於病人生命末期不接受維生處置的意向，與生命末期照護知識未達顯著相關，但與年齡呈正相關、與教育程度呈負相關。結論：家屬對於其COPD家人的維生處置意願普遍瞭解不足。其對於病人不予維生處置的意向程度，依病人的病情狀態、預後以及所接受的維生處置種類而有差異。專業人員應提供COPD家屬充分的維生處置訊息，建立以家庭脈絡為主的預立醫療計畫策略，以促進家屬與COPD病人末期照護議題的溝通。

關鍵字

維生醫療 ； 慢性阻塞性肺疾病 ； 生命末期 ； 家屬 ； 知識

並列摘要

Purpose: Families play a primary role in the decision-making of LST (life-sustaining treatments) especially as the patients become too impaired to make decisions. To explore the intention of families toward withholding LST for their relatives with COPD (chronic obstructive pulmonary disease) and its related factors. Method: A cross-sectional descriptive research design was used in this study. The human subject research review committee of the study hospital granted approval of this study. Participants' intention regarding withholding life-sustaining treatments was assessed from a validated instrument that consisted of twelve different life-sustaining interventions under various situations. Data were collected through interview by the researcher. Results: A total of 82 family caregivers participated in the study with a mean age of 51 years old. Most of the respondents (83%) are the children or spouses of the patients. Over one half of the families (56%) thought that the LST decision should be made by the patients themselves, although they reported that they had not known their loved one's willingness toward end of life treatments yet. If death is inevitable imminent, 80% of the families would like patients to receive comfort care rather than life-prolonging treatments. Of all LST options, the most acceptable treatment was intravenous medications such as antibiotics or other drugs. There was less intention to receive invasive treatments like endotracheal intubation and tracheostomy. Families displayed poor knowledge about LST. Families' knowledge of LST was not related to LST intentions. This study found a significant relationship between LST intentions and age, education level, and knowing the patients' willingness regarding treatment preferences (p＜.05). Conclusion: More dialogue is needed between families and patients. The findings of this study can serve as a foundation for family-based advance care planning strategies as we strive to build a mutual communication of LST with families.

並列關鍵字

life-sustaining treatments(LST) ； Chronic Obstructive Pulmonary Disease(COPD) ； end-of-life(EoL) ； family, knowledge